Fatal cardiac and renal allograft rejection with lenalidomide therapy for light-chain amyloidosis

We describe a patient who underwent a successful heart and kidney transplant for light-chain amyloidosis. She had an excellent hematologic response to bortezomib/dexamethasone therapy. Follow-up therapy with lenalidomide was started, and the patient quickly had a fatal allograft rejection of the heart and kidney. We present evidence to support the theory that lenalidomide, a known immunomodulator, may have stimulated the immune system and precipitated the fatal rejection episode. The authors report the case of a 68-year-old woman who underwent a successful combined heart and kidney transplant for amyloidosis, was then started on lenalidomide therapy, and died 2 weeks later, likely because of lenalidomide-related severe rejection of both organs.